Worden School of Social Service
FIELD EDUCATION APPLICATION
MSW ONLINE PROGRAM (Non-San Antonio Placement)
1. Contact information:
Name: / Gender: / Student ID#:Mailing Address, include city, state, zip code
Telephone Numbers / Cell:
Can text? Yes No / Home: / Work:
OLLU Email Address:
Do you speak another language? If so, specify: / Conversational:
Type “Yes” if fluent: Speak ; Read ; Write
2. What term are you scheduled to start field?
Type of Placement / Terms and Year / Field Education Course SequenceMSW Foundation Level (450 hour internship completed after first year of coursework – 6000 level courses completed except for field education course sequence) – 3 eight-week terms totaling a 24 week period / 61578251 / 6158
8252 / 6159
8253
MSW Advanced/Concentration Level (500 hour internship completed after ALL coursework – 7000 level courses – for the MSW degree has been completed except for field education course sequence) – 3 eight-week terms totaling a 24 week period / 71578356 / 7158
8256 / 7159
8257
If you have completed other Social Work internships, identify the agency and when completed? / BSW:
MSW Foundation:
3. Are you requesting ADA accommodations for Field Education? If yes, you must register with Disability Services and attach a letter with specific accommodation requests for Field Education with this application or note date request submitted to Disability Services. / Yes / No
4. Do you plan on applying for a work-based placement? If yes, complete and submit the Application to Use Student’s Place of Employment as Field Placement Site part of this form. / Yes / No
5. List the pre-screened contact information of the MSW, licensed MSW if required in the state (i.e. LMSW), or LCSW who has tentatively consented to serve as your Field Instructor.
Potential Field Instructor’s Name:Potential Field Instructor’s Credentials (LMSW/LCSW):
Potential Field Instructor’s Phone Number w/Area Code
Potential Field Instructor’s Email Address:
Potential Field Education Agency:
Potential Field Education Program within Agency:
Potential Field Education Agency/Program Website URL:
Date Contact Initiated: / Date of Last Contact:
Summarize your conversation with the Potential Field Instructor in the box below. Include key points and information that may be relevant to the Field Education Office when they make contact with the agency.
6. Is there any information pertinent to your field placement that has not been identified in this application, including requests for field placement where you or a family member have received services? / Yes / No
7. Are you requesting placement at a location that is owned by a family member or a family friend? / Yes / No
A response of yes to either question may signal a dual relationship that could result in an ethical dilemma. If you responded yes, please discuss the information with the MSW Online Field Education Coordinator or provide a written discussion here:
You may not start Field Education until the below mentioned documents have been read and your understanding of these are acknowledged in this application. / Yes / No
8. Have you ever been convicted of or charged with a crime in any state or country, the disposition of which was other than acquittal or dismissal? If yes, please explain:
9. Field placement sites often require fingerprinting and completion of a criminal history background check. I acknowledge the need to discuss this with the MSW Online Field Education Coordinator. Do you acknowledge your understanding that placement may be delayed for a term until another placement can be confirmed should you choose non-disclosure that impacts a referral or results in the loss of a placement?
10. I understand that I am financially responsible for the cost of any background checks, immunizations, TB check, drug test, etc. required by my field placement site.
11. Have you read the current NASW Code of Ethics? Do you agree to abide by the NASW Code of Ethics in your field placement?
12. Are you aware that violations of the NASW Code of Ethics in field placement can lead to termination from Field Education courses and, if warranted, termination from your degree program?
13. Have you read the Worden School of Social Service Student Code of Conduct? Do you agree to abide by it in field placement?
14. Are you aware that violations of the Worden School of Social Service Student Code of Conduct in field placement can lead to termination from Field Education courses, and if warranted, termination from your degree program?
15. Have you read the guidelines regarding Communication Expectations? Do you agree to abide by the procedures noted on this page?
16. I understand that all computer hardware, software, network access, information and data provided to me as a social work student intern is the property of the agency in which I will be placed and should be used for official agency purposes only. I will not use the agency computer systems for personal or non-agency business related purposes. Do you agree to adhere to agency policy?
17. Field Education requires you to have access to a computer having mini-camera functionality so your Faculty Liaison can conduct required face-to-face field placement site visits (using Skype) with you and your Field Instructor. I understand that I must have this capability ready by the time I start Field Education.
18. Applicable only to MSW Concentration Students: The MSW concentration is practice with Hispanic children and families. I understand that if the agency I have identified cannot afford opportunities to gain culturally competent knowledge, skills, and values through practice with some Hispanic clients that it will not be approved as a field placement site.
19. Applicable only to MSW Concentration Students: If Hispanic populations do not exist in my community, I understand that I may need to commute or relocate at my own expense to meet Field Education requirements or delay completion of Field Education until a suitable placement is approved.
20. I understand that Field Education is limited to locations in the United States or DoD jurisdictions which adhere to the NASW Code of Conduct.
21. I understand placement at a potential site isn’t guaranteed for diverse reasons (i.e., terms of affiliation agreement not accepted by University, field instructor is not certified based on required credentials, site cannot take on students after all, etc.)
22. I understand that Field Education must be completed under the supervision of a Field Instructor who has earned an MSW degree from a CSWE-accredited program, has two years of post-MSW direct practice experience, and if licensure is required by the jurisdiction in which the student is completing placement, is licensed.
23. Digital Signature: By typing my name in the box below, I attest that I have completed this form, agree to the time length and hour commitment, and confirm my digital signature.
Name: / Date:
Incomplete Field Education Applications will be returned to student for completion.
CHECKLIST OF DETAILS: Watch for Engage Field Education Workgroup posted deadlines, announcements, and Q&A webinars
þ Proofread that all items have been completed and digitally signed.
þ Per Question 3, if applying for ADA accommodations, letter from Disability Services
WHERE TO SUBMIT APPLICATION DOCUMENTS:
þ Address a single email to .
þ Attach this application and any required documentation to it. Do not send multiple emails.
þ Type in the email subject line: “Ap Term (designate term, e.g. SP16 Term B) your first & last name”
Questions? Contact the Worden School of Social Service Field Education Office
at or 210-431-3969 Central Standard Time
Worden School of Social Service
Field Education Office
RELEASE OF STUDENT INFORMATION CONSENT FORM
The Family Educational Rights and Privacy Act of 1974 (FERPA) is a federal law that protects the privacy of a student’s financial and academic educational records by limiting release of student information without the student’s explicit written consent.
The Field Education Office is often required to provide documentation and information about a student as part of the field placement process. Please review, complete and sign this form to authorize release of your educational records, information about your academic standing, and/or information required by an agency such as, but not limited to, proof of US citizenship or valid student visa, immunizations, and results of a drug screen or criminal history check.
STUDENT PERMISSION FOR RELEASE OF INFORMATIONSignature and Declaration: I understand information may be released orally or in written records, as preferred by the requestor. I acknowledge that this release is valid until I have completed my Field Education placement or until I revoke this release in writing by notifying the Field Education Office listed on this form. By signing this release, I authorize OLLU’s Worden School of Social Service, Field Education Office to release any and all information for the purpose of Field Education.
Sign either the digital signature or the handwritten signature. Only one is required.
Digital Signature / ID #
Handwritten Signature / Date
OLLU Email
Please mail, fax, or email completed form to:
Our Lady of the Lake University
WSSS Field Education Office
411 S.W. 24th Street
San Antonio TX 78207
Email:
Fax: 210-431-4028
Worden School of Social Service
Field Education Office
communication EXPECTATIONS
The MSW Field Education Team is committed to working with students applying for Field Education. Each placement involves a concerted effort to form a collaborative relationship with a potential field placement site. Students have an integral role in this process. The Field Education Team relies on the student to communicate in a professional and timely manner.
As a professional courtesy, if circumstances arise after the student has applied for Field Education that will prohibit the student from beginning Field Education that term, a simple email to the MSW Field Education Coordinator acknowledging this is greatly appreciated.
Communicating in a professional and timely manner includes:
· Meeting deadlines
· Responding to requests for a meeting or return call in a timely manner
· Providing information needed to process an application in a timely manner
· Communicating in a courteous, respectful, or collegial tone.
· Living up to OLLU’s core values of community and integrity which are expressed through the quality of our relationships.
To foster effective communication and prevent barriers to placement, the following procedures will be followed.
1. If a student misses the Field Education application deadline announced, placement will be delayed by at least one term due to failure to adhere to the application deadline. The only exception is when a student has been actively communicating with their field coordinator and diligently seeking placement prior to the deadline. In this instance, the field coordinator may grant these students an extension on their application deadline.
2. Once the student has submitted all documentation required as part of the Field Education application process, adherence to the following behavioral expectations will take effect.
a. The student will be required to check their OLLU email on a regular basis.
b. The student will be required to respond to email requests within 48 hours or according to the deadline noted in the email.
c. When a meeting is requested, the student will be required to submit an email providing three (3) possible times for a virtual face-to-face meeting with the MSW Field Education Coordinator.
d. The student will be required to complete the virtual face-to-face meeting as arranged.
e. In preparation for the meeting, the student will be required to view the recorded Field Education Q&A Webinar which is available through Engage.
3. Non-compliance with these expectations will result in being officially transitioned to the next term.
4. Non-enrollment for six consecutive terms (12 months) will require re-applying to the MSW Program.
Please note when Field Education is delayed, this results in a break from other coursework until Field Education requirements are met.
Worden School of Social Service
STUDENT CODE OF CONDUCT
In order to fulfill its Mission, the Worden School of Social Service matriculates students who show the greatest academic and social work professional promise to actualize the Mission in the classroom and the community. In order to assist students to achieve their maximum potential as both student and future social worker, the Faculty enforces this Student Code of Conduct as an enhancement of the OLLU Student Handbook policies. Students are expected to act ethically, morally, and honestly in all facets of their life as a student. The Faculty therefore set out the following codes of behavior:
Readiness and Willingness to Learn: Students must engage in learning in all coursework, and all assignments within courses, in a manner that demonstrates a willingness and readiness to acquire new knowledge and skills deemed vital to professional social work practice by the Faculty. Accepting differences and new ways of seeing the world is part of this readiness and is based on the NASW Code of Ethics. This includes, in particular, the readiness to serve all people, regardless of race, ethnicity, national origin, gender, sexual orientation, gender identity, gender expression, disability, religion, creed, age, or socioeconomic status.
Academic Performance: Students must meet grade requirements, as established in the BSW and MSW Student Handbooks and Manuals and in the OLLU Undergraduate and Graduate Bulletins. Students not maintaining these requirements or engaging in academic misconduct, which includes but is not limited to plagiarism, are subject to immediate consequences which can result in dismissal from the School’s academic programs. Plagiarism includes, but is not limited to: copying others’ work and claiming it as one’s own, failing to use citations properly, cheating on tests and homework assignments, using a single paper in multiple courses without explicit permission and copying or purchasing papers from the internet or other sources.